Dentistry and Antibiotics

It has long been the standard of care for a patient with an artificial heart valve to take antibiotics before a dental visit. But over the last 40 years how and when to take those medicines has changed. The American Heart Association makes changes to their guidelines from time to time. Once upon a time you took antibiotics for 7 days just to get your teeth cleaned. Now you just take some an hour before your appointment. Also, it used to be everyone with a heart murmur also needed to take medicine but no more. The American Dental Association says that dentists are to follow the American Heart Association guidelines so your dentist can give you a prescription for your dental visit.

There has long been some controversy about a patient with artificial hips, knees, shoulders and the like. The thinking was that bacteria is introduced to the blood stream during dental work and you did not want that to cause an infection on your artificial joint. Even amoung the surgeons who perform the procedures there has never been agreement. Some surgeons want their patient to take antibiotics and some don't. Even with the surgeons who wanted the medications, the prescriptions would be different. A patient with an artificial hip might have been told to "take antibiotics for their dental visits" but no guidelines were given to the poor patient. Many times I have been told by a patient that their "doctor" wanted them on antibiotics but with no guidance. It was up to the dentist to either give their best guess or try to track done the surgeon to get an answer.

In January 2015 the American Dental Association (ADA) made a strong ruling on this issue. "In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection." They said this because there is no scientific evidence that taking antibiotics prior to dental care will protect an artificial joint. Also, that the bacteria introduced to the blood stream has a much less chance of causing a problem than taking the antibiotic. There are definate risks in taking any medication including allergy. Also everytime you take an antibiotic your body is changed and a tolerance is started. Many people can tell you about getting a yeast or fungal infection when they take antibiotics. This is because of the good bacteria in your body are changed with antibiotics.

I could not have been happier with this ruling by the ADA and I hope people with articial joints will be happy too. What this means though is that your dentist cannot give you an antibiotics for your replacement joint. If you surgeon still wants you to take something for a dental visit, then fine. But your surgeon will have to be the one to give your the presciption, your dentist can no longer do that. This clearly is something that will improve your dental experience and remove any misunderstandings between the patient and their dentist.